Ibuprofen for Dengue Fever? Absolutely Not!
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News
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2024-11-05
Since 2024, the dengue fever epidemic situation has been severe, with the intensity of transmission significantly exceeding that of the same period in previous years. Affected by the epidemic and weather conditions, the risk of imported and local dengue fever cases in Guangdong Province is high this year, and it is still in the peak season.
What is Dengue Fever
Dengue fever (DF) is an acute infectious disease caused by the Dengue virus (DENV) and transmitted through the bite of Aedes mosquitoes. The general population is susceptible, and some individuals develop the disease after infection. Its clinical features include sudden onset of fever, generalized pain, rash, bleeding, lymphadenopathy, and leukopenia. Severe dengue patients may experience multi-organ hemorrhage, shock, organ failure, and even death【1】.
How is Dengue Fever Treated
There is no specific antiviral therapy for dengue fever. Current treatment primarily focuses on symptomatic and supportive care (e.g., bed rest, fever reduction, fluid replacement).
(1) Fever Reduction: Physical cooling is the first choice. For patients with persistent high fever, acetaminophen can be used, while ibuprofen and aspirin should be used with caution. Patients with G6PD deficiency (favism) should use antipyretic and analgesic drugs cautiously to prevent hemolysis【2】.
(2) Fluid Replacement: Oral rehydration is the mainstay for mild cases. Intravenous fluid therapy should be administered promptly for severe cases or when necessary.
(3) Sedation and Analgesia: Diazepam can be administered for symptomatic treatment.
(4) Volume Management: For severe patients, fluid therapy should be adjusted promptly based on hematocrit, platelet count, electrolytes, urine output, and hemodynamic status.
(5) Anti-Shock Therapy: Fluid resuscitation should be initiated as soon as possible.
(6) Treatment of Disseminated Intravascular Coagulation (DIC): Anticoagulation therapy, improving microcirculation, correcting acidosis, and supplementing coagulation factors and platelets.
(7) Treatment of Hemorrhage: Local hemostasis or administration of acid-suppressing drugs (e.g., omeprazole) and somatostatin for gastrointestinal bleeding. For severe bleeding, symptomatic transfusion of red blood cells or platelets is indicated.
(8) Traditional Chinese Medicine Treatment: Chinese herbal medicine or proprietary Chinese medicines can be used based on the clinical symptoms at different stages and phases of the disease.
Why Dengue Patients Should
Use Ibuprofen with Caution for Fever
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). Its use in dengue patients may pose the following risks:
(1) Inhibits Platelet Aggregation, Worsening Bleeding: Ibuprofen exerts analgesic, anti-inflammatory, and antipyretic effects by inhibiting cyclooxygenase (COX) in prostaglandin (PG) synthesis, preventing the conversion of arachidonic acid to prostaglandins (PG) and thromboxane A2 (TXA2). This simultaneously affects platelet aggregation, potentially leading to bleeding, worsening bleeding, and prolonging bleeding time. Long-term use may also cause agranulocytosis, leukopenia, thrombocytopenia, and even irreversible damage such as aplastic anemia and hemolytic anemia.
Dengue patients, after being infected by the dengue virus, are already in a state of vasodilation and bleeding. Taking ibuprofen can easily worsen bleeding and even lead to intracranial hemorrhage.
(2) Reduced Protective Effect on the Gastrointestinal Mucosa: Prostaglandins (PG) have the function of inhibiting gastric acid secretion and protecting the gastric mucosa. However, ibuprofen inhibits the production of prostaglandins (PG), which may cause ulcers and even bleeding.
(3) Affects Kidney Function: Ibuprofen may increase the burden on the kidneys, leading to further impairment of renal function and affecting normal metabolism and waste excretion. This effect is more pronounced in dengue patients under stress.
Therefore, dengue patients should avoid using NSAIDs such as ibuprofen to prevent worsening of the condition.
How to Reduce Fever in Dengue Patients
with G6PD Deficiency
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused by a gene defect, commonly known as favism. After consuming fava beans or specific drugs, patients lacking the G6PD enzyme to counteract oxidative damage are prone to red blood cell rupture, triggering acute hemolytic anemia.
The World Health Organization classifies this disease into four categories based on G6PD enzyme activity levels and the risk of hemolysis:
When a patient with favism has a fever, the method of fever reduction should be chosen by assessing the G6PD enzyme activity level and the risk of hemolysis. Physical cooling is the priority. Patients with mild favism can use normal doses of acetaminophen under the guidance of a doctor or pharmacist.
For patients with Class I favism, who already have chronic anemia, the use of acetaminophen for fever reduction is generally not recommended; physical cooling methods are preferred. Additionally, it is important to note that patients with favism must not take traditional Chinese medicines or proprietary Chinese medicines containing heat-clearing and detoxifying herbs such as honeysuckle, ox gallstone, or coptis【3】.
References:
【1】Chinese Guidelines for the Clinical Diagnosis and Treatment of Dengue Fever (2018).
【2】Chinese Guidelines for the Clinical Diagnosis and Treatment of Dengue Fever (2024).
【3】Expert Consensus on Newborn Screening, Diagnosis, and Treatment of Glucose-6-Phosphate Dehydrogenase Deficiency (2017).
